You may or may not have read about the morcellator issues with the potential to spread cancer cells, but it’s been out there and all non vaginal hysterectomies don’t require the use of that tool; however it gave United Healthcare the fuel they needed to cut costs and require approval for non vaginal procedures. The problem stated in the story here is that there’s not enough doctors that know how to do the non vaginal procedures, so here we go with procedure needing to be approved ahead of time and the MDs having to submit data to substantiate such.

So once again the insurer, United says they know better than the doctors it appears. Sure if a vaginal procedure is available and is recommended by a doctor, it’s one less item to heal but again you need the doctors trained to do so. Sometimes a vaginal procedure may not work depending on other things going on with a woman’s health too.

So here we go, as they seized the opportunity to take over the decision making for the doctors and again using the morcellator as the vehicle to drive this. United is pretty well known for driving down pay for MDs and in the OC where I am, many of them tell me the net payments from the company end up being less than what Medicare pays. Maybe they are counting on the money saved here to help finance more stock buy backs too? United has a big one and also has to finance dividends for shareholders too.

On a related note, Johns Hopkins is taking United to court as they narrowed them out of the network for some of their insured, mostly those who buy a policy from an insurance exchange, where United pays the doctors somewhere between Medicaid and Medicare rates.

When the procedures is all done, we have this United/Dignity company that’s going around looking for contracts with hospitals to take over all the revenue cycling too, which involves firing current employees (maybe hiring some back) of a hospital to do all the billing and revenue cycle work. If they get contracts with hospitals, even outside of the Dignity chain they are doing now (Dignity is their 49% partner), they can wipe the slate clean on billing and analyzing each procedure done. There should be a law against “too big to fail insurers”, you think?

The nation’s largest health insurer is imposing tighter controls on its coverage for hysterectomies after more than a year of debate over a medical device that was found to spread hidden cancer in some women undergoing the procedure.

Only vaginal hysterectomies performed on an outpatient basis won’t require prior approval. The method, in which the uterus is removed through the vagina, has long been considered both the least invasive and cheapest option yet is used in only about 15% to 20% of cases, according to federal data and studies. The technique hasn’t been emphasized enough in medical training, many doctors say.

Still, prior authorization had been uncommon for hysterectomies. Among the major commercial insurers, only Anthem Inc. requires them. A spokeswoman said the company started the practice last year over concerns that doctors weren’t fully considering alternatives to hysterectomies to treat fibroids.

Cigna Corp. and Aetna Inc. said they don’t require the extra step. “We believe this is best left up to the physician and patient based on clinical circumstances,” an Aetna spokeswoman said.

Dark Arts of Mathemical Deception

Professor Charlie Siefe of NYU, a mathematician debunks clinical trials, and few other items to where data is spun and fools you, every day example, hear about the perfect butt algorithm and more. These are probably some things you have never thought about but again after listening to what he has to say, it’s time to think about being skeptical. Here’s a radio show that also talks about the same topics.

This video digs in a bit further with how fictitious business models are used by banks and companies do this too. The models are so complex that CEOs don’t even understand them. “Quants, The Alchemists of Wall Street will take you through how “math models” work at banks and financial institutions in a way that even the layman can understand. More videos like over at theAlgo Duping/Killer Algorithm Page. Bank of America will also tell you“IT’ is a business” how they make money.

Weapons of Math Destruction

This is a lecture where Kathy O’Neill, a former Quant who worked for a Hedge Fund (Weapons of Math Destruction) on Wall Street will tell you what is done with your retirement money and more. The banks and companies use technology to take advantage because they can. “Of course we are going to take advantage because our tools are our brains…if they could figure out a way to take advantage of pension funds they would, a good interview with explaining smart money and dumb money.

Algorithms Shape The World

This is a very good presentation done a TED Conference and really was the one that got everyone started thinking about algorithms and today it’s talked about a lot. As he says “if you’re an algorithm, life is looking pretty good, but can’t say the same for humans”. What is a black box? Nobody has any control over the flash crash. We have moved forward a bit but still we are writing the unreadable and lost the sense of some of what is happening. Nice plug for Nanex here with research.